Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re inval...

Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re inval...

Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re inval...

SSM Health is an Equal Opportunity Employer:Community Description:About SSM Health St. Mary's Hospital - Madison: SSM Health-Dean Medical Group, a 500-physician multi-specialty group, is actively recruiting a Cardiothoracic Surgery Physic...

Multi-Specialty Peer Review Committee Coordinator in San Francisco/Bay Area contract Opportunity! This Jobot Consulting Job is hosted by: Robert Reyes Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resu...

clinical review note to support determination Concurrently monitors resource utilization, performing continued stay reviews... to grow core competencies across the teams. Performs other duties as required. Perform Auth Certifications and reviews...

and debugging complex issues. This job also participates in code reviews to maintain high code quality and share knowledge...

resolution of escalated cases that may require special handling. Performs clinical reviews according to the policies... and software to manage cases and document reviews. Promotes business focus which demonstrates an understanding of the company...

: Performing reviews of appraisal reports for multifamily residential (5+ units) and/or commercial properties to determine the... to ensure that appraisal reviews are complete, accurate, adequate, relevant, and reasonable based on sound real estate appraisal...

Consultant (Registered Nurse) supports our community clinical staff through completing Licensed Health Professional (LHP) reviews...

, Recovery, and Enforcement Act of 1989 (FIRREA) and internal appraisal requirements Completion of appraisal reviews to JPMC...

and process improvements Support Integrated Product Teams (IPTs) and participate in design reviews Represent engineering...

, concurrent, and discharge utilization reviews. Facility regulatory compliance by ensuring proper documentation and allocation... financial and clinical results. Leads payer engagement activities including post payment reviews, payer audit oversight...

: The Concurrent Utilization Review (UR) Nurse is responsible for conducting real-time clinical reviews to ensure the... Director and clinical leadership for complex cases, denials, and escalated reviews. Key Responsibilities: 1. Concurrent...

retrospective reviews, applying established clinical criteria, policies, and regulatory guidelines to determine medical necessity... necessity criteria tools such as InterQual or MCG. Extensive knowledge in claims reviews includes retrospective reviews, pre...

, concurrent, and discharge utilization reviews. Facility regulatory compliance by ensuring proper documentation and allocation... financial and clinical results. Leads payer engagement activities including post payment reviews, payer audit oversight...

to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include...

credit risk reviews plans and objectives for reviews. Robust understanding of the credit cycle and economic indicators...

. How you'll contribute A Utilization Review Specialist who excels in this role: Facilitate clinical reviews for all patient... for denied services. Coordinate with physicians to schedule peer-to-peer reviews with payers. Accurately track and report...

Resolves problems related to donor records Investigates ABO exceptions, pending reviews, and determines if quarantines...